There are powerful "macro-level" determinants of health that are fixed within populations, but which vary between populations. We hypothesize that quantifiable national macro-level determinants can be identified that will explain variation in oral health above and beyond variation attributable to characteristics of individuals within nations. Objectives: In response to PAR-06-219, the goals of this two-year planning project are to develop a study protocol and funding applications to investigate macro-level determinants of oral health related quality of life (OHRQoL). The project has four Specific Aims: 1) to assemble a collaborative team of researchers who have measured OHRQoL in six national surveys;2) to establish new collaborations with researchers from other disciplines so that we can identify a comprehensive set of macro-level determinants;3) to undertake preliminary studies of hypothesized macro-level determinants of oral health from each country;and 4) to develop a detailed study protocol that would undertake analysis of available datasets with multiple levels of health determinants. Relevance: These aims are of direct relevance to Goal 7 of the NIH/NIDCR strategic plan that seeks to "Assess the social, educational and economic impact of oral ... conditions" and of Healthy People 2010 which aims "to help individuals of all ages increase life expectancy and improve their quality of life". Research design: During the first year of NIH funding, we will hold one face-to-face investigators'meeting and monthly teleconference calls among the applicants. The meetings will be concerned primarily with hypothesis generation and identification of data sources. Between meetings, pilot studies will be undertaken to address methodology at each of the applicant institutions (Adelaide, Australia;Newcastle, UK;and Oulu, Finland). The primary outcomes for Year 1 will be: a) expansion of the team of investigators to include five additional consultants;b) compilation of a data dictionary describing oral health survey items and macro-level variables available in six countries;and c) methodological pilot studies examining macro-level determinants of oral health within three of the collaborating countries. In Year 2, we will identify new contextual variables, finalize hypotheses and complete pilot studies for the Year 2 grant application. At the second face-to-face meeting of the expanded group of investigators, pilot investigations conducted during Year 1 will be reviewed. Those results will also help finalization of the conceptual framework that was initiated in Year 1. We will spend the remainder of the year working with newly-recruited investigators to identify data sources from their own disciplines (e.g. geography, economics) that will be included in the Year 2 grant application. We will also complete the manuscript begun in Year 1 and submit it for publication. Finally, we plan to submit funding applications to at least two agencies that support international collaborative studies. Project Narrative: This project is relevant to public health because it will develop a study identifying "macro-level" features of nations that influence population oral health. Examples of macro-level determinants include social services and health programs, both in the public and private sector. In addition to identifying upstream causes of health disparities within countries, the planned study can point to health policy interventions needed to improve health in those nations.